Voice of Dissension: When Nurse Teamwork and Patient Safety Diverge | Off the Charts

Juliana Paradisi writes, "I’m beginning to wonder if too much emphasis on team building may also diminish a nurse’s unique voice, thereby inadvertently interfering with patient safety?"

This is tragically timely for me. For the first time during my blogging career, I am speaking out without buffers or anonymity to unambiguously answer Paradisi's question with a resounding "yes."

Before I begin, my erstwhile boss sent me the following relevant company policies, and I believe I've addressed them:

  1. Personal Blogs should be written in the first person and, where your connection to [company] is apparent or references [company], have clear disclaimers that the views expressed by the author in the Blog is the author’s alone and do not represent the views of [company]. [This post does not express the views of the institution, and I am a former employee of this institution anyway.]

  2. Information published on your Blog(s) should comply with the [company's] confidentiality and disclosure of proprietary data policies. This also applies to comments posted on other Blogs, forums, and social networking sites. [I am not aware of any "proprietary data policies" and will not be identifying specific clients.]

  3. Be aware your online communications via images, posts, or comments may reflect on [company]. At no time should you make defamatory statements about [company], staff members, or management. Employees are permitted to express personal opinions regarding the workplace, work satisfaction or dissatisfaction, wages hours or work conditions through personal electronic communications. [These cannot coexist, but I will do my best.]

A client experienced a serious event, possibly a sentinel event, depending on how you want to argue it. As one of the two involved nurses, I voiced dissent with the harmful policies and behaviors I observed from staff, including providers, with the intent of remediation and prevention of anything like it happening again.

My dissent grew stronger very quickly as it was ignored and I saw dangerous behaviors praised to avoid hurt feelings. I was frankly seriously alarmed. My supervisor repeatedly told me that these things occurred because of the need for teamwork. We could not single people's mistakes out because it hampered the team. (We could, however, clearly single people out for undeserved and dangerous praise.)

I composed a series of e-mails trying to get across my concerns about client safety and requesting a proper medical debriefing that included the responding nurses and the physician of record, standard stuff. The debriefing was agreed to, to my relief, except rather than its occurring I was terminated for the reason that the job was just not a good professional fit. Among other things cited, I was not a good team member. To proceed further would perhaps be defamatory and probably not support the point of my post, so I will simply reiterate that my not being a good team member was the ultimate reason given for this bad fit.

Paradisi writes:

As one nurse said, “Sometimes you just have to let things break.” I’m okay with this philosophy when it’s applied to changing a process, but not if patient safety is sacrificed. I know I’m not the only nurse with these experiences. It begs the question: “When is the voice of dissension imperative to patient safety regardless of being part of a team?”

I would like to think I would do the same thing again, but I truly loved that job. And I was good at it. I enjoyed going to work, and I enjoyed interacting with the clients. I received constant feedback that I was really good at the work, and I think that reflects job satisfaction as well. Those things are valuable and difficult to come by. So had I known that being the voice of dissension would get me fired, would I have tried so hard? Spoken out so strongly? Would I have been able to continue working there with that brand of "teamwork" evident even if I had not been terminated, knowing that the "team" superseded patient safety?

I don't know. I am devastated at the loss of this enjoyable job, I miss the clients, and I feel extremely disillusioned and distressed. This is the first time I have ever seen "team" so clearly pitted against what to me is an obviously more important concern, and I am stunned. Paradisi's post probably would have floated past my consciousness before, but now I see the point and urge every nurse to think about it before it happens, because I see now it was only a matter of time in my career.

As nurses we are called upon to be patient advocates, and of necessity that role will often conflict with others' concept of "team." It's a problem. And yes, right now it's a problem that personally saddens and alarms me.